Side effects of chemotherapy

Chemotherapy drugs stop cancer cells dividing and growing. Some healthy cells also constantly divide and grow, so they can be affected too and this can cause side effects. As healthy cells can repair themselves quickly, side effects are usually temporary.

Chemotherapy affects people in different ways. Some people experience very few side effects while others have more. Different chemotherapy drugs have different side effects too. Below are some of the more common side effects.

Nausea and vomiting

Nausea can start immediately after having the chemotherapy or up to several hours later. It can last for several hours or for as long as several days. It can usually be controlled or at least lessened with anti-sickness (also known as anti-emetic) drugs. Some people find complementary therapies like relaxation therapy, hypnosis or acupuncture helpful.

Sore mouth

You may have a sore mouth or gums, or develop mouth ulcers, so good mouth hygiene is important during treatment. If you already have tooth decay or gum disease, see your dentist so that these can be sorted out before treatment starts.

Hair loss

Hair loss can be one of the most distressing side effects of chemotherapy. Hair loss usually happens gradually and begins within two to three weeks of starting treatment, though it may be much more sudden. You may lose all your body hair, including eyebrows and eyelashes. Your hair should grow back after treatment has finished. Prolonged hair loss has been reported in a very small number of cases with some drugs.

Bone marrow suppression

Chemotherapy can affect the bone marrow (the spongy material within bones), meaning that it is less able to make new blood cells. Before each course of chemotherapy you’ll have a blood sample taken. This is to make sure that the levels of these cells are within safe limits for you to have the treatment. Sometimes blood cells can be affected to such a degree that treatment is postponed. Blood cells generally recover sufficiently within a week, and treatment can start again.

White blood cells in particular can be affected by chemotherapy. They are responsible for fighting infection. Your nurses and doctors will give you advice about when your white blood cells may be low and about trying to avoid infection. It is important to tell your GP or hospital where you are having your chemotherapy treatment as soon as possible if you develop any sign of infection such as a high temperature, feeling unwell or a sore throat.

Tiredness (fatigue)

You may become very tired during your treatment. Some people find that this lasts for several months after their treatment has finished. If you become anaemic (have low numbers of red blood cells) you are more likely to feel tired, although you may still be tired even if your blood cell levels are normal. You may also find that the treatment affects your ability to concentrate or think clearly.

Sore eyes and runny nose

The drug 5FU used in some chemotherapy treatments can cause sore, gritty eyes and a runny nose. Eye drops may relieve the soreness. It is best to ask your specialist team or chemotherapy nurse to prescribe or advise on which eye drops to use as ones bought over the counter are not always recommended.

Diarrhoea

You may have some diarrhoea (loose bowel movements) but medication will help control it. If you experience diarrhoea ask your specialist team or chemotherapy nurse for advice on what medication to take to help with this side effect.

Urinary problems

It’s important to drink plenty of fluid when you have your treatment as chemotherapy drugs (particularly cyclophosphamide) can irritate the lining of the bladder. Tell your specialist team or chemotherapy nurse if you notice any irritation or pain when going to the toilet.

Epirubicin will make your urine red for up to 24 hours after you have your treatment. This can be alarming but is a normal side effect of the drug.

Fertility

Some younger women find their periods become irregular or stop temporarily while they're having chemotherapy. Others find that they stop completely, which may indicate permanent infertility. The likelihood of this depends on your age and the drugs you are having.

Women around 40 and above are less likely to get their periods back after completing chemotherapy than women under this age. If you’re concerned about your fertility, it's important to talk to your specialist team before treatment begins.

You may want to read our factsheet, Fertility issues and breast cancer treatment, which you can download from the right hand side of this page.

Menopausal Symptoms

Because chemotherapy can cause periods to become irregular or stop temporarily or permanently, some women may also experience menopausal symptoms. Menopausal symptoms may include hot flushes, decreased sex drive and mood changes. Low levels of oestrogen (because of an early menopause) can also mean an increased risk of osteoporosis developing.

If you have concerns about your bone health or experience menopausal symptoms, please talk to your specialist team or chemotherapy nurse about how best to manage these.